Sage Journals: Discover world-class research

Abstract

Purpose:

This study aimed to assess early outcomes of the single port (SP) robotic low anterior access (LAA) for all upper urinary tract surgeries. In addition, it aimed to explore the impact of clinical factors, notably Body Mass Index (BMI), on post-operative outcomes and length of hospital stay.

Materials and Methods:

Overall, 76 consecutive patients underwent SP robotic surgery with LAA involving all upper urinary tract pathologies, with data collected prospectively. Baseline characteristics, intra- and post-operative outcomes, pain levels, and opioid use were analyzed. Statistical methods, including logistic regression and locally weighted scatterplot smoothing analysis, were used to assess same-day discharge (SDD) predictors and the association between BMI and SDD probability. According to the Institutional Review Board (IRB) protocol, only data recorded in our electronic medical record system was included.

Results:

Ten different procedures were performed with LAA, with no need for conversion to open surgery and complication rates in line with the literature (30 days: 5%, 90 days: 6.6%). Notably, 77.6% of patients were discharged on the same day. A significant association was found between BMI and prolonged hospital stay, particularly in obese patients (BMI ≥30 kg/m²). Post-operative pain was generally low (median VAS: 4), with over 70% discharged without opioid prescriptions.

Conclusions:

The novel LAA is a versatile approach for various upper urinary tract surgeries, including in obese patients. While achieving satisfactory post-operative outcomes, increased BMI correlated with a reduced likelihood of SDD. Further studies, including larger cohorts and multicenter collaborations, are warranted to explore anesthesiologic management and validate these findings.

Get full access to this article

View all access options for this article.

References

Ragavan

, Dholakia

, Ramesh

, et al. Extraperitoneal vs. transperitoneal robot-assisted laparoscopic radical prostatectomy-analysis of perioperative outcomes, a single surgeon's experience. J Robot Surg, 2019;13(2):275–281; doi: 10.1007/s11701-018-0850-1

Mills

, Burris

, Warburton

, et al. Positioning injuries associated with robotic assisted urological surgery. J Urol, 2013; 190(2):580–584; doi: 10.1016/j.juro.2013.02.3185

Akhavan

, Gainsburg

, Stock

. Complications associated with patient positioning in urologic surgery. Urology, 2010; 76(6):1309–1316; doi: 10.1016/j.urology.2010.02.060

Pellegrino

, Chen

, Morgantini

, et al. Simplifying retroperitoneal robotic single-port surgery: Novel supine anterior retroperitoneal access. Eur Urol, 2023; 84(2):223–228; doi: 10.1016/j.eururo.2023.05.006

Abaza

, Murphy

, Bsatee

, et al. Single-port robotic surgery allows same-day discharge in majority of cases. Urology, 2021; 148:159–165; doi: 10.1016/j.urology.2020.08.092

Kaouk

, Aminsharifi

, Wilson

, et al. Extraperitoneal versus transperitoneal single port robotic radical prostatectomy: A comparative analysis of perioperative outcomes. J Urol, 2020; 203(6):1135–1140; doi: 10.1097/JU.0000000000000700

Clavien

, Barkun

, de Oliveira

, et al. The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg, 2009; 250(2):187–196; doi: 10.1097/SLA.0b013e3181b13ca2

Palacios

, Morgantini

, Trippel

, et al. Comparison of perioperative outcomes between retroperitoneal single-port and multiport robot-assisted partial nephrectomies. J Endourol, 2022; 36(12):1545–1550; doi: 10.1089/end.2022.0346

Kaouk

, Aminsharifi

, Sawczyn

, et al. Single-port robotic urological surgery using purpose-built single-port surgical system: Single-institutional experience with the first 100 cases. Urology, 2020; 140:77–84; doi: 10.1016/j.urology.2019.11.086

10.

Rich

, Okhawere

, Nguyen

, et al. Transperitoneal versus retroperitoneal single-port robotic-assisted partial nephrectomy: An analysis from the single port advanced research consortium. Eur Urol Focus, 2023; 9(6):1059–1064; doi: 10.1016/j.euf.2023.06.004

11.

Garg

, Singh

, Sinha

, et al. Prospective randomized comparison of transperitoneal vs retroperitoneal laparoscopic simple nephrectomy. Urology, 2014; 84(2):335–339; doi: 10.1016/j.urology.2014.04.038

12.

Covas Moschovas

, Bhat

, Rogers

, et al. Applications of the da Vinci single port (SP) robotic platform in urology: A systematic literature review. Minerva Urol Nephrol, 2021; 73(1):6–16; doi: 10.23736/S2724-6051.20.03899-0

13.

Vigneswaran

, Schwarzman

, Francavilla

, et al. A comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy. Eur Urol, 2020; 77(6):671–674; doi: 10.1016/j.eururo.2020.03.031

14.

Veres

, Petrovics

, Sárvári

, et al. The effect of laparoscopic pre- and postconditioning on pneumoperitoneum induced injury of the peritoneum. Clin Hemorheol Microcirc, 2019; 73(4):565–577; doi: 10.3233/CH-190572

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.62 MB